My journey into health policy and advocacy began early in my nursing career and has evolved in tandem with my professional growth. Like many nurses, my first experience occurred as an undergraduate student, when we traveled to the state capital for Nurses Day on the Hill. Standing among hundreds of nurses united in purpose left a lasting impression. It was my first realization that nurses have the power to influence decisions. This early exposure sparked a deeper interest that continued into my graduate education, where policy-focused assignments required direct engagement with local and state officials. What began as an academic requirement quickly transformed into a professional responsibility. Since then, I have participated in State and National Nurses Day on the Hill events, each reinforcing the importance of a collective nursing voice in shaping healthcare policy. One particularly formative experience was attending the American Association of Colleges of Nursing (AACN) Student Policy Summit, a national event dedicated to educating nursing students about health policy and advocacy.1 Hearing directly from lobbyists, congressional staffers, and policy representatives was both eye-opening and inspiring. They emphasized that nurses’ perspectives are not only welcomed but sought after and that decision-makers want to hear from us. It was equally sobering to learn that although nurses represent the largest segment in the healthcare workforce, with more than 4 million Registered Nurses (RNs) compared with ~933,788 physicians in the United States,2 our influence often lags behind that of our medical colleagues. This disparity has been attributed to several factors, including persistent stereotypes and outdated images of nursing, a perceived inability to influence political decision-making, beliefs that policy advocacy falls outside the professional scope of nursing, limited confidence and mentorship, and insufficient knowledge of policymaking processes and strategies.3,4 I also witnessed instances where misinformation about the safety and effectiveness of advanced practice registered nurses (APRNs) created barriers to progress and hindered the implementation of necessary policy changes. These experiences collectively planted the seed for what has become a defining part of my professional identity: advocating for the recognition and advancement of the Clinical Nurse Specialist (CNS) role in health policy at local, state, and national levels. Why CNS representation matters The CNS role is essential to achieving high-quality, cost-effective, and evidence-based healthcare. Despite this, the CNS remains invisible in several key federal classifications. The Bureau of Labor Statistics (BLS) does not currently list the CNS as a distinct category within the Standard Occupational Classification (SOC) system.5 Although the SOC includes a broad category for Registered Nurses (29-1141) and assigns separate codes for Nurse Anesthetists (29-1150), Nurse Midwives (29-1160), and Nurse Practitioners (29-1170), it does not identify CNSs as a distinct occupation. Instead, CNSs are subsumed under broader nursing classifications, which diminishes visibility, limits accurate workforce data, and constrains policy and funding decisions directly impacting advanced nursing practice. As the President-Elect of the National Association of Clinical Nurse Specialists (NACNS), I am actively engaged in national efforts to secure federal recognition and title protection for CNSs. The NACNS Statement on CNS Practice and Education emphasizes that recognition is not simply a matter of professional pride; it is essential for accountability, workforce planning, and sustainability.6 Accurate classification ensures that healthcare systems can track, support, and leverage the CNS workforce to its full potential. Without this visibility, the unique and measurable contributions of CNSs risk being overlooked, and our collective impact diluted. Balancing clinical practice with policy work For many nurses, policy work may seem distant from clinical practice, but I view them as inseparable. Policy decisions shape the environments in which we work and influence every aspect of patient care. I integrate advocacy into my professional life in both small and large ways. Sometimes it is as simple as writing an email or making a phone call; at other times, it involves participating in Hill Days, serving on committees, or contributing to discussions on organizational policy. My memberships in the American Nurses Association (ANA) and the National Association of Clinical Nurse Specialists (NACNS) have been particularly meaningful. These organizations provide powerful platforms for collective advocacy, amplifying the nursing voice. Through them, I can contribute to initiatives that advance the nursing profession, promote patient-centered policies, and elevate the role of the Clinical Nurse Specialist within healthcare systems. Policy engagement is a natural extension of clinical practice and is grounded in the same commitment to improving health outcomes and strengthening nursing practice. Advocacy in action: my roles and activities Over the years, my advocacy efforts have taken many forms. As a member of the NACNS Michigan CNS Affiliate board of directors, I helped lead the successful effort to secure title protection for CNSs in 2017.7 This work involved developing testimony, submitting letters of support, and collaborating with lobbyists whose efforts were supported through member contributions. A successful outcome demonstrated how organized, collective advocacy can produce meaningful policy change at the state level. Today, as President-Elect of NACNS, my advocacy focuses on advancing the federal classification of CNSs within the Standard Occupational Classification system, supporting workforce development initiatives, and removing barriers to APRN scope of practice, enabling CNSs to practice to the full extent of their education and training. Across these initiatives, my work has consistently centered on elevating the visibility and influence of CNSs, advancing nursing education, and improving access to high-quality, evidence-based care. Each of these efforts reflects a single guiding principle: nursing voices must be present at every table where healthcare decisions are made. Essential skills for policy advocacy While nursing education lays a strong foundation in communication, I have learned that advocacy requires developing additional skills that are rarely emphasized in traditional curricula.4 The first is message framing, crafting a clear and compelling message that resonates with your target audience without overwhelming or alienating them. Clarity, brevity, and alignment with shared goals are essential to capturing attention and sustaining engagement.8 Storytelling is a powerful advocacy tool. While data provides essential evidence, it rarely shifts perspectives on its own. When paired with a patient’s story, data becomes both meaningful and memorable. Equally important is relationship-building, particularly with legislative staffers who often serve as gatekeepers to elected officials and influence policy decisions. Collaboration is also critical. Advocacy efforts gain strength when nurses unite across specialties and partner with patients to present a cohesive, amplified voice.8 Building relationships and navigating workplace boundaries Engaging with policymakers does not need to be intimidating or complex. Begin by attending a local town hall, coffee chat, or community listening session. Send a brief, professional email introducing yourself as a nursing expert and offering to serve as a resource on health-related issues. Nurses are consistently ranked as the most trusted profession, and credibility provides a powerful foundation for building relationships and exerting influence.8 Equally important is maintaining clear boundaries between advocacy and employment. I keep my advocacy work separate from my professional role by using my personal email address and phone number when contacting elected officials. Many organizations have policies governing political activity, and it is essential to respect these while still embracing our professional responsibility to advocate for evidence-based health policy.9 By navigating these boundaries thoughtfully, nurses can remain both compliant and deeply engaged in shaping the policies that affect our patients and our profession. Overcoming barriers and fear Fear remains one of the most significant barriers preventing nurses from engaging in policy work, fear of not knowing what to say, saying the wrong thing, or feeling unqualified to contribute.3 Many nurses also assume that advocacy is time-consuming or requires advanced policy expertise. In reality, advocacy can be as simple as making a single phone call, sending a single email, or having a single meaningful conversation. Small actions, repeated over time, create meaningful change. Another common barrier is the lack of connection to professional organizations. Membership in groups such as the American Nurses Association (ANA) or the National Association of Clinical Nurse Specialists (NACNS) provides access to essential resources, mentorship, and real-time policy updates. These organizations offer toolkits and templates that simplify the process and make advocacy approachable.8,9 Once nurses experience how straightforward and rewarding advocacy can be, many wonder why they did not begin sooner. The unique power of nurses’ voices Nurses are uniquely positioned to influence health care policy. We are the largest segment of the health care workforce, present in every corner of the system and the community, and we are consistently ranked as the most trusted profession.10 Nearly everyone has been cared for by a nurse, knows a nurse, or has a family member who is a nurse. This deep connection enables us to communicate in ways that resonate with the public and policymakers. We are natural translators of complex medical information, skilled at breaking down technical language and highlighting real-world impact. By using stories to bring data to life, we can make policy issues personal, urgent, and impossible to ignore. Lessons for graduate students and emerging CNS leaders For graduate nursing students interested in policy, my advice is simple: join a professional nursing organization and become actively involved. Attend meetings, serve on committees, and volunteer for projects that align with your interests. Professional organizations regularly share policy updates, legislative alerts, and advocacy opportunities. They also provide practical tools such as template letters, talking points, and step-by-step guidance for contacting elected officials and other decision-makers. Equally important is developing a deep understanding of the policies themselves. Read beyond the headlines to examine the full content, rationale, and implications of proposed legislation. This level of understanding enables you to clearly explain policy issues to others and anticipate how they may impact nursing practice, patient outcomes, and health care systems. When communicating with legislators or their staff, begin by introducing yourself and explaining your area of expertise. Offer to serve as a resource on health-related issues and share your perspective as a CNS or advanced practice nurse. Building relationships over time helps establish trust and positions nurses as credible experts and valued partners in shaping evidence-informed health policy. Looking ahead: policy priorities for the next decade Several policy issues will be critical for the nursing profession in the coming years. The first is federal recognition of CNSs. Without proper classification within national workforce systems, CNSs will continue to encounter challenges related to workforce planning, reimbursement, and role protection. Recognition is essential not only for visibility but also for ensuring accurate data collection and informed policy decisions that sustain the CNS workforce. The second priority is the development of the nursing workforce. The nation must invest in education, retention, and career advancement to ensure that nurses are available in every setting where healthcare is delivered. Building and sustaining a diverse, well-prepared workforce is vital to addressing the evolving needs of patients and communities. Finally, removing barriers to the APRN scope of practice remains essential. Patients deserve access to the full breadth of nursing expertise, and outdated regulatory restrictions continue to limit that access. Aligning practice authority with education and competency promotes efficiency, equity, and quality in care delivery. Conclusion: a call to action Advocacy is not separate from practice; it is part of our role as CNSs. Our patients and our profession depend on us to speak up. Every nurse has a voice, and policy needs our perspective. If my journey has taught me anything, it is that policy is not an intimidating arena reserved for others. It is a space where nursing knowledge, evidence, and values are urgently needed, and where our voices truly belong. Conflicts of interest The author reports no conflicts of interest.
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Jackeline Iseler (2025) studied this question.